Download Enteral Therapy

Caring for Individuals
Experiencing
Gastrointestinal/Digestive
Challenges
NURS 2016
Nausea
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A subjective experience, wavelike sensation in
the back of the throat, epigastrium, or abdomen
that may lead to the urge or need to vomit
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Increased salivation
Aversion toward food
Gagging
Sour taste
Increased swallowing
Nursing Management of Nausea
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Identify cause
Eliminate or minimize noxious substance
or irritants
NPO, clear fluids or bland diet
Antiemetics – dimenhydrinate (caution if
cause is not known)
Vomiting
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Forceful projection of contents from the
stomach
Symptom of numerous diseases and
treatments
Nursing Management of Vomiting
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Identify cause and eliminate or minimize
NPO
Monitor emesis
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Amount, consistency, colour
Triggers and timing
Monitor fluid balance: non-enteral fluid
replacement
Monitor electrolyte balance: non-enteral
electrolyte replacement (Na+ and K+)
Gastritis
Inflammation of gastric mucosa
Acute: short infrequent episodes, often
related to food or drink
Chronic: longer duration – ulcer
– may be related to bacterial invasion (helicobacter
pylori)
Peptic Ulcers
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Doudenal
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Mid adulthood
Males more often
Lots of HCL stomach acid
Wt gain (feed it)
Pain 2-3 hours pc
Bleed rare (melena)
Higher perforation rate
H.pylori, alcohol, smoking,
cirrhosis, stress
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Gastric
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Older adults
Even sex ratio
Low or normal HCL
½ to 1 hour pc
Vomiting common
Bleed common
(hematemesis)
H.pylori, alcohol, smoking,
NSAIDs, stree
Nursing Care of Ulcers
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Relieving pain
Reducing anxiety
Maintaining nutritional status
Monitoring/managing complications
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Hemorrhage
Perforation
Pyloric obstruction
Management
Managing Complications Cont’d:
 Perforated diverticulum
 Peritonitis
Diet
Pharmacological
Surgical
Irritable Bowel Syndrome
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8-15% of population
Peristaltic waves affected at specific
segments of bowel
Bloating, constipation or diarrhea,
cramping, gas
Quality of Life
Nursing Care of IBS
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Primarily an educational role
regarding monitoring diet
and reducing stress
Hydrophilic colloids
(psyllium)
Avoid excess intake of fluids
with food
Give anti-diarrhea agents
(loperamide)
Anti- depressants
Anticholinergics &Ca Channel
Blockers
Study findings
 Nurses believed
pts were
demanding and
difficult
 Low pain
tolerance and
crave attention
 Nurse had
insufficient
knowledge and
not interested in
more
Diverticular Disease
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Diverticulum
Diverticulosus
Diverticulitis
Complications
 Peritonitis
 Abscess formation
 Bleeding
Nursing Care - Diverticulitis
Goals
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Aimed primarily at comfort and rest
Monitoring development of complications
Working with client to identify ‘triggers’
Interventions
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Assess: bowel patterns, dietary habits, tenesmus,
Palpate - LLQ for fecal mass
Inspect /Lab test – for fecal content for pus, blood and mucus
Monitor I & O, bowel patterns
Ensure fluid intake - 2L/day + fiber to add bulk in stool & peristalsis
Stool softener/enemas
Analgesic (Meperidine) + Anti- spasmodic
Bowel Obstruction
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Partial or complete
impairment of forward flow
of intestinal contents
May be small or larg bowel
(most often small bowel,
ileum).
Complete obstruction –
surgical emergency – high
mortality if not released
Figure 38-6 Three causes of intestinal obstruction. (A) Intussusception invagination or shortening of the
colon caused by the movement of one segment of bowel into another. (B) Volvulus of the sigmoid colon;
the twist is counterclockwise in most cases. Note the edematous bowel. (C) Hernia (inguinal). The sac of
the hernia is a continuation of the peritoneum of the abdomen. The hernial contents are intestine,
omentum, or other abdominal contents that pass through the hernial opening into the hernial sac.
Bowel Obstruction: Clinical
manifestations
Small bowel
Large bowel
 Crampy, wave, colicky
 Slower progression
 No fecal or flatus
 Crampy lower abd
pain
 Peristalsis may
reverse --vomiting
 Abd distention:loops
of bowel visible
 Fecal emesis
Treatment of Obstruction
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Gastric intubation (sump)
Surgical intervention
NPO
Parenteral Hydration
Temporary or permanent ostomy
Inflammatory Bowel Disease
Crohn’s
Ulcerative Colitis
Study table on page 1041
Understand
 Therapeutic management
 Systemic complications
Inflammatory Bowel Disease
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Nutritional therapy
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Pharmacological therapy
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Low residue, high protein, high calorie
Anti-inflammatory: ASA, corticosteriods
Immunmodulators
Surgical management
Inflammatory Bowel Disease
Focus on assisting client to deal with
symptoms and treatment modalities
Nsg Dx
 Altered nutrition (less than body
requirements) related to restrictive diet,
nausea, and malabsorption
Nursing Role Common to GI
Challenges
Assessment, planning, intervening and
evaluation related to
 Pain control
 Hydration
 Nutritional Status
 Knowledge and understanding of
medication and treatment regime
Nutritional Routes
Enteral: all or most of
the GI tract is used
 Traditional
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Modified
Parenteral: GI tract is
not utilized as a
nutritional route
Enteral Therapy
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Nasogastric, gastric intubation
Gastrointestinal tract integrity preserved.
Normal sequence of intestinal hepatic
metabolism preserved.
Goal: Maintaining nutritional balance
Feeding Solutions
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Osmolality
Lactose-free
1cal/ml
Intermittent
Continuous
Nursing Considerations
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Temperature, volume, flow rate
Total fluid intake
Residual gastric content
Medication administration
TPN
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Increase nutritional status
Establish +ve Nitrogen balance
Maintain muscle mass
Promote weight gain
Enhance healing process
TPN Administration
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5-6x the solute [ ] of blood
Administer in high flow vessel (subclavian)
Large bore central line
PICC
 HICKMAM
 PORT-A-CATH
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Complications of TPN
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Pneumothorax
Air embolism
Clotted catheter line
Catheter displacement
Sepsis
Hyperglycemia or rebound hypoglycemia
Fluid overload
A glimpse at Laxatives
Bulk forming
Saline agent